42 C.F.R. § 440.220

Required services for the medically needy

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(a) A State plan that includes the medically needy must specify that the medically needy are provided, as a minimum, the following services:

(1) Prenatal care and delivery services for pregnant women.

(2) Ambulatory services, as defined in the State plan, for:

(i) Individuals under age 18; and

(ii) Groups of individuals entitled to institutional services.

(3) Home health services (§ 440.70) to any individual entitled to skilled nursing facility services.

(4) If the State plan includes services in an institution for mental diseases (§ 440.140 or § 440.160) or in an intermediate care facility for Individuals with Intellectual Disabilities (§ 440.150(c)) for any group of medically needy, either of the following sets of services to each of the medically needy groups:

(i) The services contained in §§ 440.10 through 440.50 and (to the extent nurse-midwives are authorized to practice under State law or regulation) § 440.165; or

(ii) The services contained in any seven of the sections in §§ 440.10 through 440.165.

(5) For women who, while pregnant, applied for, were eligible as medically needy for, and received Medicaid services under the plan, services under the plan that are pregnancy-related (as defined in § 440.210(a)(2)(i) of this subpart) for an extended postpartum period. The postpartum period begins on the last day of pregnancy and extends through the end of the month in which the 60-day period following termination of pregnancy ends.

(b) A State plan must specify that eligible aliens as defined in §§ 435.406(a) and 436.406(a) of this subchapter will receive at least the services provided in paragraphs (a)(4) (i) and (ii) of this section.

(c) A State plan must specify that aliens defined in §§ 435.406(b), 435.406(c), 436.406(b) and 436.406(c) of this subchapter will only be provided the limited services specified in § 440.255.

[56 FR 24011, May 28, 1991, as amended at 58 FR 4938, Jan. 19, 1993]

Notes of Decisions

Cited in 5 cases, 1997–2016 · leading case: Davis v. Shah, 821 F.3d 231 (2d Cir. 2016).

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Davis v. Shah, 821 F.3d 231 (2d Cir. 2016). “§ 1396a(a)(10)(D); 42 C.F.R. § 440.220 (a)(3). Furthermore, the.”

John Smith v. Jessie K. Rasmussen, in Her Off. Capacity as Dir. of the Iowa Dep't of Human Servs., 249 F.3d 755 (8th Cir. 2001). · cites it 2× “§§ 1396a(a)(10)(A), 1396d(a); 42 C.F.R. § 440.220 . As the Seventh Circuit has stated, under the Medicaid Act “[there are essentially] three categories of potential recipients — the ‘categorically needy,’ the ‘medically needy,’ and those whose need is determined in relation to…”

DeSario v. Thomas, 963 F. Supp. 120 (D. Conn. 1997). · cites it 2× “Plaintiffs also argue that the denial of Medicaid coverage of the requested items constitutes a denial of Medicaid coverage based on the recipient’s diagnosis, in violation of 42 C.F.R. § 440.220 (c). Finally, plaintiffs contend that the automatic exclusion of Medicaid coverage…”

John Smith v. Jessie K. Rasmussen (8th Cir. 2001). · cites it 2× “§§ 1396a(a)(10)(A), 1396d(a); 42 C.F.R. § 440.220 . As the Seventh Circuit has stated, under the Medicaid Act “[there are essentially] three categories of potential recipients--the ‘categorically needy,’ the ‘medically needy,’ and those whose need is determined in relation to…”

Davis v. Shah (2d Cir. 2016). “§ 1396a(a)(10)(D); 42 C.F.R. § 440.220 (a)(3). Furthermore, the Medicaid Act identifies a number of purely optional services that a state may provide to either the categorically needy or to both the categorically and medically needy.”

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